Abstract
BackgroundCompared to conventional thoracotomy, minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. However, it still causes significant acute postoperative pain. Truncal regional anaesthesia techniques such as paravertebral and erector spinae blocks have shown to contribute to postoperative analgesia after MITS. Satisfactory placement of an ultrasound-guided thoracic paravertebral catheter can be technically challenging compared to an ultrasound-guided erector spinae catheter. However, in MITS, an opportunity arises for directly visualised placement of a paravertebral catheter by the surgeon under thoracoscopic guidance. Alongside with thoracic epidural, a paravertebral block is considered the “gold standard” of thoracic regional analgesic techniques. To the best of our knowledge, there are no randomised controlled trials comparing surgeon-administered paravertebral catheter and anaesthesiologist-assisted erector spinae catheter for MITS in terms of patient-centred outcomes such as quality of recovery.MethodsThis trial will be a prospective, double-blinded randomised controlled trial. A total of 80 eligible patients will be randomly assigned to receive either an anaesthesiologist-assisted ultrasound-guided erector spinae catheter or a surgeon-assisted video-assisted paravertebral catheter, in a 1:1 ratio following induction of general anaesthesia for minimally assisted thoracic surgery. Both groups will receive the same standardised analgesia protocol for both intra- and postoperative periods. The primary outcome is defined as Quality of Recovery (QoR-15) score between the two groups at 24 h postoperative. Secondary outcomes include assessment of chronic persistent surgical pain (CPSP) at 3 months postoperative using the Brief Pain Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires, assessment of postoperative pulmonary function, area under the curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 h, total opioid consumption over 48 h, QoR-15 at 48 h, and postoperative complications and morbidity as measured by the Comprehensive Complication Index.DiscussionDespite surgical advancements in thoracic surgery, severe acute postoperative pain following MITS is still prevailing. This study will provide recommendations about the efficacy of an anaesthesia-administered ultrasound-guided erector spinae catheter or surgeon-administered, video-assisted paravertebral catheter techniques for early quality of recovery following MITS.Trial registrationClinicalTrials.govNCT04729712. Registered on 28 January 2021. All items from the World Health Organization Trial Registration Data Set have been included.
Highlights
Background and rationale {6a} Minimally invasive thoracic surgery (MITS) is a surgical method used to perform lung surgery through small incisions between the ribs and includes both video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) [1]
Dissemination plans {31a} The results from this clinical trial will be fully disclosed by means of publication in an international peerreviewed journal and by oral/poster presentations at national and international scientific meetings. Both positive and negative results will be reported. In conducting this randomised control trial, we aim to investigate the efficacy, in terms of quality of recovery, of either an anaesthesiologist-assisted ultrasound-guided erector spinae plane catheter or surgeon-assisted videoassisted paravertebral catheter, following induction of general anaesthesia for minimally assisted thoracic surgery
Paravertebral blocks have been widely used for analgesia after thoracic surgery for many years and are considered the “gold standard” of thoracic regional analgesic techniques [9]
Summary
Background and rationale {6a} Minimally invasive thoracic surgery (MITS) is a surgical method used to perform lung surgery through small incisions between the ribs and includes both video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) [1]. MITS can reduce postoperative pain, reduce tissue trauma and contribute to better recovery [3, 4]. It still causes severe acute postoperative pain [3]. Erector spinae plane (ESP) block has emerged as a new regional anaesthesia technique which has had promising early results in attenuating this severe acute pain of MITS. Minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. It still causes significant acute postoperative pain. To the best of our knowledge, there are no randomised controlled trials comparing surgeon-administered paravertebral catheter and anaesthesiologist-assisted erector spinae catheter for MITS in terms of patient-centred outcomes such as quality of recovery
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